Journal of Behavioral Medicine

, Volume 35, Issue 2, pp 200–210

Co-occurrence of obesity and patterns of alcohol use associated with elevated serum hepatic enzymes in US adults

  • James Tsai
  • Earl S. Ford
  • Guixiang Zhao
  • Chaoyang Li
  • Kurt J. Greenlund
  • Janet B. Croft


The aim of this cross-sectional study was to present nationally representative findings on the co-occurrence of obesity and specific patterns of alcohol use associated with elevated serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) among adults in the United States. We analyzed data from 8,373 adults aged ≥ 20 years who participated in the 2005–2008 National Health and Nutrition Examination Survey. We produced prevalence ratios by using the co-occurrence of obesity (i.e., body mass index ≥ 30.0 kg/m2 or waist circumference ≥ 102 cm in men and ≥ 88 cm in women) and specific patterns of alcohol use (i.e., non-drinkers, non-excessive drinkers, and excessive drinkers) as a predictor; elevations in serum ALT, AST, and GGT were used as an outcome variable while adjusting for covariates in multivariate regression models. Approximately 34.7% of adult men and 38.6% of adult women in the United States had co-occurrence of obesity and any alcohol use, including 16.4% of men and 9.8% of women who had co-occurrence of obesity and excessive drinking during 2005–2008. When compared to male non-drinkers without obesity after multivariate adjustment, male excessive drinkers with obesity were 3.08 (95% CI: 1.80–5.28), 2.42 (95% CI: 1.80–3.26), and 3.15 (95% CI: 1.82–5.46) times more likely to exhibit elevated serum ALT, AST, and GGT, respectively. Similarly, when compared to female non-drinkers without obesity, female excessive drinkers with obesity were 2.36 (95% CI: 1.38–4.04), 3.27 (95% CI: 1.85–5.78), and 3.43 (95% CI: 2.19–5.40) times more likely to have elevated serum ALT, AST, and GGT, respectively. The co-occurrence of obesity and excessive drinking may place adults at an increased risk for potential liver injury. Our study findings provide support for evidence-based clinical and population-based interventions that integrate health behavior change among adults who have these co-occurring risk factors.


Obesity Abdominal obesity Alcohol use Transaminase Aminotransferase Alanine aminotransferase (ALT) Aspartate aminotransferase (AST) Gamma-glutamyl transferase (GGT) 


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Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2011

Authors and Affiliations

  • James Tsai
    • 1
  • Earl S. Ford
    • 1
  • Guixiang Zhao
    • 1
  • Chaoyang Li
    • 1
  • Kurt J. Greenlund
    • 1
  • Janet B. Croft
    • 1
  1. 1.Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA

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